Rising health insurance premiums are affecting not only patients but also workers within the healthcare sector. While historically the industry has had lower uninsured rates compared with other fields, increasing plan costs have led some clinicians and staff to reconsider the value of paying high monthly premiums. The article describes how premium growth, combined with policy changes that reduced certain subsidies, has tightened budgets for clinicians who might previously have been unlikely to forgo coverage.
Joshua and Ashley Durham, who run a family medicine practice in Boise, purchased coverage through the Affordable Care Act marketplace when they started their practice in late 2023. This year, a similar plan’s monthly premium rose several hundred dollars to nearly $1,600, prompting the couple to stop paying premiums and instead pay for care out of pocket.
They relied on roughly $50,000 they had accumulated in a health savings account and have used about $9,000 of that for expenses so far this year, including physical therapy, mental health care, and contact lenses. The Durhams acknowledge the risk of going uninsured — a single serious event could lead to very large bills — but noted that their out-of-pocket spending has been lower than the annualized cost of the premiums for now.
The Durhams also described some informal workarounds: because Joshua is a primary care physician, he can sometimes self-diagnose and manage minor issues for himself and family members, and he trades care with colleagues like receiving free eye exams in exchange for free primary care.
KFF’s analysis of American Community Survey data found that in 2024, 7% of healthcare workers were uninsured, compared with 11% of all adults under age 65. Physicians were particularly unlikely to be uninsured, with just 2% lacking coverage. Nevertheless, that still leaves a meaningful number of healthcare employees who face coverage decisions as premiums rise.
These trends matter because healthier people who opt out of insurance reduce the size and health of the insured pool. Insurers then raise premiums to cover a sicker risk pool, which can cause more people to drop coverage and further drive up costs.
Congressional decisions played a role in recent affordability changes. Lawmakers did not renew pandemic-era enhanced marketplace tax credits, which had temporarily reduced premium costs for many enrollees, particularly those working for small businesses or who are self-employed. While income-based subsidies remain for lower-income enrollees, the expiration of enhanced credits increased premiums for many who had previously benefited.
Analyses and projections cited in the reporting suggest that the number of uninsured people in the U.S. could rise substantially over the coming decade because of subsidy expirations and other legislative changes. The article references CBO estimates and related analyses linking policy shifts to projected coverage losses.
Small, physician-led practices and other small businesses face particularly acute premium pressures. Representatives of independent practice groups describe premium increases as “astronomical,” saying the rising cost makes employers question the value of providing traditional coverage. Some responses employers may consider include offering higher wages in lieu of comprehensive benefits, providing minimal plans, or seeking other alternatives instead of employer-sponsored coverage.
Nearly half of marketplace enrollees in 2024 were either employed by small businesses or self-employed, and those groups include many clinical occupations such as chiropractic care and dentistry. When those enrollees lose subsidy support or face higher premiums, the financial strain can ripple through small healthcare employers and their workforces.
For clinicians with chronic health conditions or family members who need regular care, dropping coverage is often not an option. The article profiles nurse practitioner Samantha LeGault, whose employer-offered premium increased from $700 to $1,500 monthly this year to insure her family. Because she and some of her children have medical conditions, she said her family had to keep the insurance despite the significant budget impact.
LeGault reported reallocating household spending — switching to public school, cutting retirement saving, and skipping dental insurance — to meet premium costs. She estimated that about one-fifth of her income now goes toward monthly premiums.
Higher premiums are not the only driver of financial strain; large deductibles and out-of-pocket costs remain significant. The article recounts the experience of a retired healthcare executive who relied on enhanced ACA tax credits last year and paid $75 per month; when subsidies expired, her premiums rose to $800 monthly and she delayed care because of a $10,000 deductible.
Those kinds of trade-offs — putting off care, returning groceries, or keeping home temperatures high to save on utility bills — illustrate the practical consequences of making healthcare costs manageable for individuals, including those familiar with how the health system operates.
The reporting highlights informal practices that arise when clinicians face constrained access to care for themselves or family members. The American Medical Association’s code of ethics generally discourages self-treatment and treating relatives, except in emergencies or for minor, short-term problems. Some clinicians admit to filling prescriptions for family members or exchanging services with colleagues, and bioethicists noted that growing reliance on such practices may prompt reconsideration of those ethical guidelines as access tightens.
Clinicians who run their own practices are seeing the downstream effects on patients. The Durhams described writing off patient bills and offering leeway to uninsured patients when they can, but also emphasized that practices need revenue to operate. The tension between helping patients and maintaining a viable practice is a recurring theme in the reporting.
Overall, the article uses personal accounts and policy context to show how rising premiums and subsidy changes are creating harder choices for healthcare workers and small healthcare employers, with consequences for both providers and patients.